Essentia Choice Care with Medica


Essentia Choice Care with Medica

Accountable Care Organization network

Essentia Choice Care with Medica provides a unique, high-quality health care experience at a lower cost. Our friendly and professional staff deliver care in more than 50 communities in northern Minnesota, eastern North Dakota and northwestern Wisconsin. Our philosophy is to be "Here with you" to help you get the care you, when you need, close to home.

If you’re away from home and get sick or hurt, we’ve got you covered! When you travel outside the Medica service area (Minnesota, North Dakota, South Dakota and western Wisconsin) you can get network coverage by visiting a provider in the Travel Program Network. This nationwide network is one of the largest in the country. If you have children attending college outside the service area, they can use this network, too.

Plan Highlights

  • Direct access to specialists. See any primary or specialty care provider in the Essentia Choice Care network without a referral.
  • Same-day access to a care team member. Get answers to questions and help with your health care needs in the same day, including e-visits.
  • Single phone number. This one-stop approach makes it easy to ask questions about your health plan benefits, billing, care and coverage and more.
  • MyHealth online patient portal. A secure online tool for communicating with your provider, accessing your health information and more.
  • Patient assistant. Welcomes members and provides extra help when needed.
  • 20% discount on products and services at Essentia Health Skin Renewal Centers in Duluth and Fargo.

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Benefit Summary for Essentia Choice Care with Medica

Network Benefits
Overall deductible [insert benefit]
Out-of-pocket limit [insert benefit]
If you visit a health care provider's office or clinic
Primary care visit [insert benefit]
Chiropractic visit [insert benefit]
Convenience care visit [insert benefit]
Specialist visit [insert benefit]
Preventive care/screening/immunization [insert benefit]
If you have a test
Diagnostic test - lab [insert benefit]
Diagnostic test - x-ray [insert benefit]
Imaging (CT/PET scans, MRI) [insert benefit]
If you need drugs to treat your illness or condition
Generic drugs [insert benefit]
Preferred brand drugs [insert benefit]
Non-preferred brand drugs [insert benefit]
If you have outpatient surgery
Facility fee (e.g., ambulatory surgery center) [insert benefit]
Physician/surgeon fees [insert benefit]
If you need immediate medical attention
Emergency room care [insert benefit]
Emergency medical transportation [insert benefit]
Urgent care [insert benefit]
If you have a hospital stay
Facility fee (e.g., hospital room) [insert benefit]
Physician/surgeon fees [insert benefit]
Network information
Network type Accountable Care Organization network
Network area Northern Minnesota, eastern North Dakota and northwestern Wisconsin
Special features Direct access to specialists; same-day access to care team; single phone number resource; online patient portal; discounts on skin products and services.
Referrals needed No referrals needed if you see an Essentia Choice Care with Medica network provider.

How it works

Essentia Choice Care is an accountable care organization (ACO). In an ACO, groups of doctors, nurses and other health care providers work together with your health plan to provide coordinated care. You don’t need a referral when you see a provider in the Essentia Choice Care network.

» View the Summary of Benefits and Coverage for Essentia Choice Care.

» Find a physician or facility in the Essentia Choice Care network.
» See a map of provider locations in the Essentia Choice Care network.

Information sharing
One of the unique features of an ACO plan is how Medica works with your provider to coordinate your health care. By sharing member information with each other, Medica and your ACO can help you get the care you need and deliver programs and services to help you get and stay healthy. If you or your dependents don’t want Medica and the ACO to share your information with each other:

» Complete this form.
» Or call Customer Service at 952-945-8000 or 800-952-3455

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